To investigate the diagnostic value of dual-energy X-ray absorptiometry (DXA) and lumbar spine CT in the diagnosis of osteoporosis (OP) and its complications, and to evaluate their effectiveness in guiding rehabilitation exercises.

A total of 147 patients with osteoporosis (OP) admitted to our hospital between January 2020 and January 2022 were selected as study subjects, including 64 men and 83 women, with a mean age of (66.49±5.58) years. Based on the presence or absence of osteoporosis complications, the enrolled subjects were divided into a control group (73 patients with uncomplicated OP) and an experimental group (74 patients with OP and complications). Both groups underwent DXA and lumbar spine CT examinations to observe and compare the prevalence of osteoporosis and its complications diagnosed by the two methods. The 74 patients in the experimental group were randomly divided into a DXA-guided group (37 patients) and a CT-guided group (37 patients). Personalized exercise regimens were developed, and participants were followed up for 6 months to assess exercise adherence and efficacy.

① The mean bone mineral density at L₂-L₄, hip T-score, and lowest lumbar T-score in the experimental group were all lower than those in the control group, and the CT value of the L1 vertebra was significantly lower than that in the control group, with statistically significant differences (P<0.05). ② In both the control and experimental groups, the DXA T-scores and mean bone mineral density of the lumbar spine (L₂-L₄) were positively correlated with the CT values of the L₁ vertebra (P<0.001). ③DXA results in the experimental group showed that 59.46%, 22.97%, and 17.57% of patients had mild, moderate, and severe osteoporosis, respectively. Lumbar spine CT results showed that 56.76%, 27.03%, and 16.22% of patients had osteoporosis, osteopenia, and normal bone mass, respectively. The Kappa coefficient between DXA and lumbar spine CT results was 0.721, indicating a high degree of consistency between the two. ④In the experimental group, overall exercise adherence was significantly higher in the CT-guided group than in the DXA-guided group (86.5% vs. 75.7%, P<0.05). ⑤ After 6 months, the CT-guided group showed more pronounced improvements in bone density, with lumbar spine T-scores increasing from -2.33±1.25 to -2.15±1.19, while the DXA-guided group improved from -2.37±1.21 to -2.26±1.18 (P<0.05 for the difference in improvement between groups). ⑥ Pain relief was more pronounced in the CT guidance group, with VAS scores decreasing from 5.72±1.85 to 3.18±1.41, while in the DXA guidance group, scores decreased from 5.81±1.92 to 3.76±1.58 (P<0.05). ⑦ Patient satisfaction was significantly higher in the CT-guided group than in the DXA-guided group (4.35 ± 0.62 vs. 4.08 ± 0.71, P<0.05).

Both DXA and lumbar CT offer high accuracy in the clinical detection of OP and its complications; however, lumbar CT is more suitable for the detection of OP and its complications. Among patients with OP complications, personalized exercise programs based on CT-guided diagnosis were superior to DXA-guided programs in terms of improving adherence, enhancing bone density, and alleviating pain.